1.
Impact of nutrition support on clinical outcome and cost-effectiveness analysis in patients at nutritional risk: A prospective cohort study with propensity score matching.
Zhang, H, Wang, Y, Jiang, ZM, Kondrup, J, Fang, H, Andrews, M, Nolan, MT, Mu, SY, Zhang, J, Yu, K, et al
Nutrition (Burbank, Los Angeles County, Calif.). 2017;:53-59
Abstract
OBJECTIVES There is a lack of evidence regarding the economic effects of nutrition support in patients at nutritional risk. The aim of this study was to perform a cost-effectiveness analysis by comparing an adequate nutrition support cohort with a no-support cohort. METHOD A prospective observational study was performed in the surgical and medical gastroenterology wards. We identified patients at nutritional risk and the provision of nutrition support by the staff, unaware of the risk status, was recorded. Cost data were obtained from each patient's statement of accounts, and effectiveness was measured by the rate of infectious complication. To control for potential confounding variables, the propensity score method with matching was carried out. The incremental cost-effectiveness ratio was calculated based on the matched population. RESULTS We screened 3791 patients, and 440 were recruited for the analysis. Patients in the nutrition support cohort had a lower incidence of infectious complications than those in the no-support cohort (9.1 versus 18.1%; P = 0.007). This result was similar in the 149 propensity matched pairs (9.4 versus 24.2%; P < 0.001). The median hospital length of stay was significantly reduced among the matched nutrition support patients (13 versus 15 d; P < 0.001). The total costs were similar among the matched pairs (US $6219 versus $6161). The incremental cost-effectiveness analysis suggested that nutrition support cost US $392 per patient prevented from having infectious complications. CONCLUSION Nutrition support was associated with fewer infectious complications and shorter length of stay in patients at nutritional risk. The incremental cost-effectiveness ratio indicated that nutrition support had not increased costs significantly.
2.
[Clinical study on the early nutrition support in postoperative patients with critical hypertensive intracerebral hemorrhage].
Zhang, JJ, Dong, WF, Gu, SJ, Zhang, J, Xuan, HF, Xie, RL
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue. 2004;(9):552-5
Abstract
OBJECTIVE To investigate the clinical significance of early nutritional support for patients with critical hypertensive intracerebral hemorrhage (HICH) in a critical condition after operation, and the rationale of different methods of nutritional support. METHODS One hundred and seven HICH patients after operation with Glasgow coma score (GCS) 6-8 were randomly divided into three groups: early enteral nutrition (EEN) group (38 cases); early parenteral nutrition (EPN) group (35 cases), conventional treatment controls (34 cases). They were given different nutritional supports 48 hours after operation. Changes in nutritional parameters and the clinical complications in three groups after treatment were observed, and the treatment effects after 3 months were compared. RESULTS At the end of first week after operation, nutrition parameters including albumin (ALb), hemoglobin (Hgb) in EEN and EPN groups were better than those in control group(P<0.05); at the end of second week, they were differences among three groups but without statistical significance (P>0.05). The complications were higher in EPN and control groups (P<0.05 or P<0.01). The outcome was assessed 3 months after the operation in term of activity of daily life (ADL), and the result was better in EEN group than that in EPN and control groups (P<0.005). CONCLUSION Postoperative HICH patients in critical condition could be benefited with EEN, and complications could be reduced with improved prognosis.